NPIMap

Organization Active NPI

Southern Dominion Health System, Inc.

Doing business as Emporia Greensville Medical Center

  • Federally Qualified Health Center (FQHC)
  • Emporia, VA
National Provider Identifier
1982817706
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHERN DOMINION HEALTH SYSTEM, INC.
Doing business as
Emporia Greensville Medical Center
Practice address
510 N Main St
Emporia, VA 23847-1236
Phone
(434) 634-7723
Fax
(434) 634-7727
NPI assigned
May 8, 2007
Last updated
Feb 7, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHERN DOMINION HEALTH SYSTEM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
April King
Title
Ceo
Phone
(434) 696-2165

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU
Federally Qualified Health Center (FQHC) 261QF0400X VA Primary

Addresses

Primary practice location

510 N Main St
Emporia, VA 23847-1236

Mailing address

PO Box 70
Victoria, VA 23974-0070
Phone (434) 696-2165

Other identifiers 1

IdentifierTypeStateIssuer
007604394MedicaidVA

Other names 1

  • Emporia Greensville Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20021223000007 VA Part A Provider - Federally Qualified Health Center (FQHC) 0648188755 Practice locations: Emporia, VA
O20040611000631 VA Part B Supplier - Clinic/Group Practice 0648188755 Receives reassigned benefits from 25 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Amelia, VA; Dinwiddle, VA; Emporia, VA; Victoria, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982817706. Details of each certification follow.

Federally qualified health center certification: CCN 491849

Legal name
SOUTHERN DOMINION HEALTH SYSTEM INC
Doing business as
EMPORIA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 2003
Last certification
Jan 1, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1985 in VA
Enrollment address
510 N Main St
Emporia, VA 23847-1236

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D1005767SDHS Inc - Emporia Medical Center510 North Main Street, Emporia, VA 23847Provider-performed microscopyJun 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Amelia Health Care Cent4 organizations share this tax ID, including this one
Part of
Amelia Health Care Cent

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

510 N Main St
Emporia, VA 23847
Phone (434) 634-7723

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Edward H Jeter Individual Corporate DirectorBoard Member Apr 18, 1994 7.7%
Beatrice O Head Individual Corporate DirectorBoard Member Nov 15, 2010 7.7%
Mary H Stewart Individual Corporate DirectorBoard Member Apr 15, 2019 7.7%
Robert E Clement Individual Corporate DirectorBoard Member Jan 17, 2000 7.7%
April L King Individual Corporate OfficerCeo Apr 1, 2024
W-2 Managing EmployeeCeo Apr 1, 2024
Angela B Wilson Individual Corporate DirectorBoard Member Sep 16, 2002 7.7%
Julie W Ashman Individual Corporate DirectorBoard Member Nov 21, 2022 7.7%
Wanda S Hill Individual Corporate DirectorBoard Member Nov 15, 2010 7.7%
Luther M Drummard Individual Corporate DirectorBoard Member Sep 13, 2006 7.7%
Rebecca P Reitz Individual Corporate DirectorBoard Member Aug 20, 2018 7.7%
Jennifer Hardy Individual W-2 Managing EmployeeCfo Jan 8, 2024
Tracy Gee Individual Corporate DirectorBoard Member Sep 1, 2023 7.7%
April S Long Individual Corporate DirectorBoard Member Jul 16, 2018

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1982817706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "VICTORIA",
            "state": "VA",
            "postal_code": "239740070",
            "telephone_number": "434-696-2165",
            "fax_number": "434-696-1378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 N MAIN ST",
            "city": "EMPORIA",
            "state": "VA",
            "postal_code": "238471236",
            "telephone_number": "434-634-7723",
            "fax_number": "434-634-7727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN DOMINION HEALTH SYSTEM, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN DOMINION HEALTH SYSTEM, INC.",
        "enumeration_date": "2007-05-08",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "APRIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "434-696-2165"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007604394",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emporia Greensville Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Emporia, VA

Sources for this page

Verify at the official NPI Registry.